Thanks for replying everyone.
Hi, I tried changing iFPSClamp=0 to iFPSClamp=60 but somehow it keeps reverting back to =0.
It still says iFPSClamp=64 if I make the change to the .ini then re-open it but when I start the game and then exit, it is back at iFPSClamp=0 for some reason. I have no idea why this is happening.
Did you change the Default INI in the Root Directory or the one in My Documents/My Games/Fallout NV (or however it is treed)? Reason is the game overwrites the one in My Games from the Default. Which is bad as if you hose the default, that usually means reinstalling the game.
Anyway, make a back up of the default INI and make the changes in there.
As for the Monitor Refresh, that should not effect the games rendering, it only effects how many times a second the screen refreshes the pixels that are rendered by the card. However, if this is a PC monitor, then do set it to 60 Hz if you can for non 3D games. It might be OK at 120, but since Vsysnc is in the way, it will set your games refresh rate to the monitors refresh rate.
And, do you have the drivers for your monitor installed? Some games need that in order to be able to run the game properly.